Kilimanjaro Christian Medical University College, Moshi, Tanzania.
BMC Pregnancy Childbirth. 2013 Aug 29;13:166. doi: 10.1186/1471-2393-13-166.
Perinatal mortality is known to be high in Sub-Saharan Africa. Some women may carry a particularly high risk which would be reflected in a high recurrence risk. We aim to estimate the recurrence risk of perinatal death using data from a hospital in Northern Tanzania.
We constructed a cohort study using data from the hospital based KCMC Medical Birth Registry. Women who delivered a singleton for the first time at the hospital between 2000 and 2008 were followed in the registry for subsequent deliveries up to 2010 and 3,909 women were identified with at least one more delivery within the follow-up period. Recurrence risk of perinatal death was estimated in multivariate models analysis while adjusting for confounders and accounting for correlation between births from the same mother.
The recurrence risk of perinatal death for women who had lost a previous baby was 9.1%. This amounted to a relative risk of 3.2 (95% CI: 2.2 - 4.7) compared to the much lower risk of 2.8% for women who had had a surviving baby. Recurrence contributed 21.2% (31/146) of perinatal deaths in subsequent pregnancies. Preeclampsia, placental abruption, placenta previa, induced labor, preterm delivery and low birth weight in a previous delivery with a surviving baby were also associated with increased perinatal mortality in the next pregnancy.
Some women in Tanzanian who suffer a perinatal loss in one pregnancy are at a particularly high risk of also losing the baby of a subsequent pregnancy. Strategies of perinatal death prevention that target pregnant women who are particularly vulnerable or already have experienced a perinatal loss should be considered in future research.
据了解，撒哈拉以南非洲的围产期死亡率很高。一些女性可能面临特别高的风险，这将反映在高复发风险上。我们旨在利用坦桑尼亚北部一家医院的数据来估计围产期死亡的复发风险。
我们使用基于医院的 KCMC 医疗出生登记处的数据构建了一项队列研究。2000 年至 2008 年间，在该医院首次分娩单胎的女性在登记处进行后续分娩随访，直至 2010 年，有 3909 名女性在随访期间至少有一次以上分娩。在多变量模型分析中，调整混杂因素并考虑到来自同一母亲的分娩之间的相关性，估计围产期死亡的复发风险。
失去前一个婴儿的女性围产期死亡的复发风险为 9.1%。与存活婴儿的女性 2.8%的风险相比，这相当于相对风险为 3.2（95%CI：2.2-4.7）。复发在随后的妊娠中导致 21.2%（31/146）的围产儿死亡。在存活婴儿的前一次分娩中患有子痫前期、胎盘早剥、前置胎盘、引产、早产和低出生体重也与下一次妊娠的围产儿死亡率增加相关。
坦桑尼亚的一些在一次妊娠中经历围产儿死亡的女性，在下一次妊娠中也特别容易失去婴儿。未来的研究应考虑针对特别脆弱或已经经历过围产儿死亡的孕妇的围产儿死亡预防策略。
